Impaired Discrimination Research Articles

Attractiveness judgments and discrimination of mommies and grandmas: Perceptual tuning for young adult faces

Adults are more accurate in detecting deviations from normality in young adult faces than in older adult faces despite exhibiting comparable accuracy in discriminating both face ages. This deficit in judging the normality of older faces may be due to reliance on a face space optimized for the dimensions of young adult faces, perhaps because of early and continuous experience with young adult faces. Here we examined the emergence of this young adult face bias by testing 3- and 7-year-old children on a child-friendly version of the task used to test adults. In an attractiveness judgment task, children viewed young and older adult face pairs; each pair consisted of an unaltered face and a distorted face of the same identity. Children pointed to the prettiest face, which served as a measure of their sensitivity to the dimensions on which faces vary relative to a norm. To examine whether biases in the attractiveness task were specific to deficits in referencing a norm or extended to impaired discrimination, we tested children on a simultaneous match-to-sample task with the same stimuli. Both age groups were more accurate in judging the attractiveness of young faces relative to older faces; however, unlike adults, the young adult face bias extended to the match-to-sample task. These results suggest that by 3years of age, children’s perceptual system is more finely tuned for young adult faces than for older adult faces, which may support past findings of superior recognition for young adult faces.

Global versus local: double dissociation between MT+ and V3A in motion processing revealed using continuous theta burst transcranial magnetic stimulation.

The functional properties of motion selective areas in human visual cortex, including V3A, MT+, and intraparietal sulcus (IPS) are not fully understood. To examine the functional specialization of these areas for global and local motion processing, we used off-line, neuronavigated, continuous theta burst (cTBS) transcranial magnetic stimulation to temporarily alter neural activity within unilateral V3A, MT+, and IPS. A within-subjects design was employed and stimulation sessions were separated by at least 24 h. In each session, subjects were asked to discriminate the global motion directions of successively presented random dot kinematograms (RDKs) before and after cTBS. RDKs were presented at either 100 or 40 % coherence in either the left or right visual field. We found that V3A stimulation selectively impaired discrimination of 100 % coherent motion, while MT+ stimulation selectively impaired discrimination of 40 % coherent motion. IPS stimulation impaired discrimination of both motion stimuli. All cTBS effects were specific to stimuli presented contralaterally to the stimulation site and vertex stimulation had no effect. The double dissociation between the cTBS effects on MT+ and V3A indicates distinct roles for these two regions in motion processing. Judging the direction of 100 % coherent motion can rely on local motion processing because every dot moves in the same direction. However, judging the global direction of 40 % coherent motion requires global processing. Thus, our results suggest separate, parallel processing of local and global motion in V3A and MT+, respectively, with the outputs of these two areas being combined within the IPS.

HOW SHOULD WE ASSESS FUNCTIONAL PERFORMANCE IN INDIVIDUALS WITH MILD COGNITIVE IMPAIRMENT (MCI)?

Background: The olfactory identificationdysfunction in amnestic mild cognitive impairment (aMCI) which precedes mainly Alzheimer disease (AD) is well known and is considered to be caused by AD pathology. The presence of olfactory impairment in non amnestic MCI (naMCI) and patients with subjective memory complaint (SMC) is controversial. The aim of this study was to examine the degree of objective and subjective olfactory dysfunction in aMCI, naMCI and SMC. Methods: 92 patients with aMCI and 32 patients with naMCI, 28 SMC patients and 50 age matched healthy controls underwent a multiple choice olfactory identification test with 18 different odors developed in our memory clinic. Results: Both aMCI and naMCI patients showed impairment in olfactory identification test compared to both controls and SMC (p<0.01). There was no difference between aMCI and naMCI groups and between SMC and controls in olfactory identification. Conclusions: The olfactory identification impairment in naMCIand aMCI isindistinguishable. NaMCI often converts to Frontotemporal lobar degeneration, dementia with Lewy body or Vascular dementia and the olfactory deficit found in this study could be explained by the recently demonstrated olfactory impairment in these dementia subtypes. SMC patients do not have any significant olfactory discrimination impairment.

Contrasting Effects of Histone Deacetylase Inhibitors on Reward and Aversive Olfactory Memories in the Honey Bee.

Much of what we have learnt from rodent models about the essential role of epigenetic processes in brain plasticity has made use of aversive learning, yet the role of histone acetylation in aversive memory in the honey bee, a popular invertebrate model for both memory and epigenetics, was previously unknown. We examined the effects of histone deacetylase (HDAC) inhibition on both aversive and reward olfactory associative learning in a discrimination proboscis extension reflex (PER) assay. We report that treatment with the HDAC inhibitors APHA compound 8 (C8), phenylbutyrate (PB) or sodium butyrate (NaB) impaired discrimination memory due to impairment of aversive memory in a dose-dependent manner, while simultaneously having no effect on reward memory. Treatment with C8 1 h before training, 1 h after training or 1 h before testing, impaired aversive but not reward memory at test. C8 treatment 1 h before training also improved aversive but not reward learning during training. PB treatment only impaired aversive memory at test when administered 1 h after training, suggesting an effect on memory consolidation specifically. Specific impairment of aversive memory (but not reward memory) by HDAC inhibiting compounds was robust, reproducible, occurred following treatment with three drugs targeting the same mechanism, and is likely to be genuinely due to alterations to memory as sucrose sensitivity and locomotion were unaffected by HDAC inhibitor treatment. This pharmacological dissection of memory highlights the involvement of histone acetylation in aversive memory in the honey bee, and expands our knowledge of epigenetic control of neural plasticity in invertebrates.

Attentional capture by spoken language: effects on netballers’ visual task performance

In two experiments, participants performed visual detection, visual discrimination and decision-making tasks, in which a binary (left/right) response was required. In all experimental conditions, a spoken word (“left”/“right”) was presented monaurally (left or right ear) at the onset of the visual stimulus. In Experiment 1, 26 non-athletes located a target amongst an array of distractors as quickly as possible, in both the presence and absence of spoken cues. Participants performed superiorly in the presence of valid cues, relative to invalid-cue and control conditions. In Experiment 2, 42 skilled netballers completed three tasks, in randomised order: a visual detection task, a visual discrimination task and a netball decision-making task – all in the presence of spoken cues. Our data showed that spoken auditory cues affected not only target detection, but also performance on more complex decision-making tasks: cues that were either spatially or semantically invalid slowed target detection time; spatially invalid cues impaired discrimination task accuracy; and cues that were either spatially or semantically valid improved accuracy and speeded decision-making time in the netball task. When studying visual perception and attention in sport, the impact of concomitant auditory information should be taken into account in order to achieve a more representative task design.

Circuit-Wide Structural and Functional Measures Predict Ventromedial Prefrontal Cortex Fear Generalization: Implications for Generalized Anxiety Disorder

The ventromedial prefrontal cortex (vmPFC) plays a critical role in a number of evaluative processes, including risk assessment. Impaired discrimination between threat and safety is considered a hallmark of clinical anxiety. Here, we investigated the circuit-wide structural and functional mechanisms underlying vmPFC threat-safety assessment in humans. We tested patients with generalized anxiety disorder (GAD; n = 32, female) and healthy controls (n = 25, age-matched female) on a task that assessed the generalization of conditioned threat during fMRI scanning. The task consisted of seven rectangles of graded widths presented on a screen; only the midsize one was paired with mild electric shock [conditioned stimulus (CS)], while the others, safety cues, systematically varied in width by ±20, 40, and 60% [generalization stimuli (GS)] compared with the CS. We derived an index reflecting vmPFC functioning from the BOLD reactivity on a continuum of threat (CS) to safety (GS least similar to CS); patients with GAD showed less discrimination between threat and safety cues, compared with healthy controls (Greenberg et al., 2013b). Using structural, functional (i.e., resting-state), and diffusion MRI, we measured vmPFC thickness, vmPFC functional connectivity, and vmPFC structural connectivity within the corticolimbic systems. The results demonstrate that all three factors predict individual variability of vmPFC threat assessment in an independent fashion. Moreover, these neural features are also linked to GAD, most likely via an vmPFC fear generalization. Our results strongly suggest that vmPFC threat processing is closely associated with broader corticolimbic circuit anomalies, which may synergistically contribute to clinical anxiety.

Losing face: impaired discrimination of featural and configural information in the mouth region of an inverted face

Given that all faces share the same set of features-two eyes, a nose, and a mouth-that are arranged in similar configuration, recognition of a specific face must depend on our ability to discern subtle differences in its featural and configural properties. An enduring question in the face-processing literature is whether featural or configural information plays a larger role in the recognition process. To address this question, the face dimensions task was designed, in which the featural and configural properties in the upper (eye) and lower (mouth) regions of a face were parametrically and independently manipulated. In a same-different task, two faces were sequentially presented and tested in their upright or in their inverted orientation. Inversion disrupted the perception of featural size (Exp. 1), featural shape (Exp. 2), and configural changes in the mouth region, but it had relatively little effect on the discrimination of featural size and shape and configural differences in the eye region. Inversion had little effect on the perception of information in the top and bottom halves of houses (Exp. 3), suggesting that the lower-half impairment was specific to faces. Spatial cueing to the mouth region eliminated the inversion effect (Exp. 4), suggesting that participants have a bias to attend to the eye region of an inverted face. The collective findings from these experiments suggest that inversion does not differentially impair featural or configural face perceptions, but rather impairs the perception of information in the mouth region of the face.

Different roles for M1 and M2 receptors within perirhinal cortex in object recognition and discrimination

Recognition and discrimination of objects and individuals are critical cognitive faculties in both humans and non-human animals, and cholinergic transmission has been shown to be essential for both of these functions. In the present study we focused on the role of M1 and M2 muscarinic receptors in perirhinal cortex (PRh)-dependent object recognition and discrimination. The selective M1 antagonists pirenzepine and the snake toxin MT-7, and a selective M2 antagonist, AF-DX 116, were infused directly into PRh. Pre-sample infusions of both pirenzepine and AF-DX 116 significantly impaired object recognition memory in a delay-dependent manner. However, pirenzepine and MT-7, but not AF-DX 116, impaired oddity discrimination performance in a perceptual difficulty-dependent manner. The findings indicate distinct functions for M1 and M2 receptors in object recognition and discrimination.

Neonatal phencyclidine administration and post-weaning social isolation as a dual-hit model of ‘schizophrenia-like’ behaviour in the rat

Schizophrenia is a debilitating disorder comprising positive, negative and cognitive deficits with a poorly defined neurobiological aetiology; therefore, animal models with greater translational reliability are essential to develop improved therapies. This study combines two developmental challenges in rats, neonatal phencyclidine (PCP) injection and subsequent rearing in social isolation from weaning, to attempt to produce more robust behavioural deficits with greater translational relevance to schizophrenia than either challenge alone. Forty-two male Lister-hooded rat pups received the N-methyl-D-aspartate (NMDA) receptor antagonist, phencyclidine (PCP, 10mg/kg, s.c.), or vehicle on post-natal day (PND) 7, 9 and 11 and were weaned on PND 23 into group housing (saline-treated n = 11 or PCP-treated n = 10) or isolation (saline n = 10 or PCP n = 11). Six weeks post-weaning, novelty- and PCP-induced (3.2mg/kg) locomotor activity, novel object discrimination, prepulse inhibition of acoustic startle and contextual memory in a conditioned emotion response (CER) were recorded. Isolation rearing alone significantly elevated baseline locomotor activity and induced visual recognition memory impairment in novel object discrimination. Neonatal PCP treatment did not induce locomotor sensitisation to a subsequent acute PCP injection, but it impaired prepulse inhibition when combined with isolation rearing. CER freezing behaviour was significantly reduced by isolation rearing but an even greater effect occurred when combined with neonatal PCP treatment. Neonatal PCP and isolation rearing both produce behavioural deficits in adult rats, but combined treatment caused a wider range of more severe cognitive impairments, providing a more comprehensive preclinical model to determine the neurobiological aetiology of schizophrenia than either treatment alone.

Vertigo and Sudden Hearing Loss at 35 000 Feet

Awoman in her 70s presented after experiencing a sudden rightsidedhearing loss duringdescent ona commercial air flight. She reportedright-sidedtinnitus,otalgia,andvertigowithnauseaandvomiting.Hermedical history includedeustachian tubedysfunctionand pressure-induced tympanicmembraneperforations; however, she deniedahistoryof vertigo. TheWeber test lateralized to the left ear using a 512-Hz tuning fork. Cranial nerves III toVII and IX toXIIwere normal. Thepatientwasnonambulatoryandcomplainedofmotioninduced vestibular symptoms. Audiometric test results revealed a right-sided profound mixed hearing loss with severe discrimination impairment, and the left ear hada severehigh-frequencyhearing losswith normalworddiscrimination. The right pure-tone average (PTA)was 85 dB and the left was 22 dB. Shewas treatedwith a prednisone taper, and a right ventilation tube was placed in anticipation of possible eustachian tube problems with future air travel. Vestibular and balance symptoms improved with vestibular rehabilitation and physical therapy over the next several months. Repeated audiometric tests 1 month after the incident revealed a PTA of 17 dB and 15 dB on the right and left sides, respectively, with normal bilateral word discrimination. Subjective right hearing had returned to its baseline status. Shown herein are a noncontrast computed tomographic (CT) image of the head (Figure, A), CT images of the right temporal bone in the axial plane (Figure, B and C), and a right coronal oblique CT image (Stenver projection) (Figure, D). What is your diagnosis? A B

Impairment of Emotional Facial Expression and Prosody Discrimination Due to Ischemic Cerebellar Lesions

A growing literature points to a specific role of the cerebellum in affect processing. However, understanding of affect processing disturbances following discrete cerebellar lesions is limited. We administered the Tübingen Affect Battery to assess recognition of emotional facial expression and emotional prosody in 15 patients with a cerebellar infarction and 10 age-matched controls. On emotional facial expression tasks, patients compared to controls showed impaired selection and matching of facial affect. On prosody tasks, patients showed marked impairments in naming affect and discriminating incongruencies. These deficits were more pronounced for negative affects. Our results confirm a significant role of the cerebellum in processing emotional recognition, a component of social cognition.

A synchronous surround increases the motion strength gain of motion

Coherent motion detection is greatly enhanced by the synchronous presentation of a static surround (Linares, Motoyoshi, & Nishida, 2012). To further understand this contextual enhancement, here we measured the sensitivity to discriminate motion strength for several pedestal strengths with and without a surround. We found that the surround improved discrimination of low and medium motion strengths, but did not improve or even impaired discrimination of high motion strengths. We used motion strength discriminability to estimate the perceptual response function assuming additive noise and found that the surround increased the motion strength gain, rather than the response gain. Given that eye and body movements continuously introduce transients in the retinal image, it is possible that this strength gain occurs in natural vision.

Self‐Rated Social Skills Predict Visual Perception: Impairments in Object Discrimination Requiring Transient Attention Associated with High Autistic Tendency

Autism is usually defined by impairments in the social domain but has also been linked to deficient dorsal visual stream processing. However, inconsistent findings make the nature of this relationship unclear and thus, we examined the role of stimulus-driven transient attention, presumably activated by the dorsal stream in autistic tendency. Contrast thresholds for object discrimination were compared between groups with high and low self-rated autistic tendency utilizing the socially based Autism Spectrum Quotient (AQ). Visual stimuli were presented with either abrupt or with ramped contrast onsets/offsets in order to manipulate the demands of transient attention. Larger impairments in performance of abrupt compared with ramped object presentation were established in the high AQ group. Furthermore, self-reported social skills predicted abrupt task performance, suggesting an important visual perception deficiency in autism-related traits. Autism spectrum disorder may be associated with reduced utilization of the dorsal stream to rapidly activate attention prior to ventral stream processing when stimuli are transient.

Electrophysiology Correlates of Successful and Impaired Auditory Discrimination in Acquired Comprehension Impairments

Wernicke's aphasia is a condition which results in severely disrupted language comprehension following a lesion to the left temporo-parietal region. A phonological analysis deficit has traditionally been held to be at the root of the comprehension impairment in Wernicke's aphasia, a view consistent with current functional neuroimaging which finds areas in the superior temporal cortex responsive to phonological stimuli. However behavioural evidence to support the link between a phonological analysis deficit and auditory comprehension has not been yet shown. This study extends seminal work by Blumstein, Baker, and Goodglass (1977) to investigate the relationship between acoustic?phonological perception, measured through phonological discrimination, and auditory comprehension in a case series of Wernicke's aphasia participants. A novel adaptive phonological discrimination task was used to obtain reliable thresholds of the phonological perceptual distance required between nonwords before they could be discriminated. Wernicke's aphasia participants showed significantly elevated thresholds compared to age and hearing matched control participants. Acoustic?phonological thresholds correlated strongly with auditory comprehension abilities in Wernicke's aphasia. In contrast, nonverbal semantic skills showed no relationship with auditory comprehension. The results are evaluated in the context of recent neurobiological models of language and suggest that impaired acoustic?phonological perception underlies the comprehension impairment in Wernicke's aphasia and favour models of language which propose a leftward asymmetry in phonological analysis. Highlights ? This study provides the first positive evidence of a link between impaired auditory comprehension in Wernicke's aphasia and disrupted auditory?phonological analysis. ? A novel test of nonword auditory discrimination is introduced. This test enables differentiation of abilities within severely impaired participants. ? Results support traditional theories of Wernicke's aphasia.

TMS to V1 spares discrimination of emotive relative to neutral body postures

This study used TMS to examine the role played by striate cortex (V1) in processing the emotional content of visual stimuli. Participants learned to discriminate two sets of body posture images. For half of each set, the posture's emotional significance (threat versus pleasant) provided a redundant cue for the discrimination; the other half were emotionally neutral. An image was briefly presented at a lateral location in the visual field where a TMS pulse produced a phosphene, or at a control location in the opposite hemifield. A TMS pulse 70–140ms after stimulus presentation at the phosphene location impaired discrimination of neutral stimuli with little effect on discrimination of emotional stimuli; the two classes of stimuli were equally discriminable when presented at the control location. The results are consistent with the proposal that emotionally salient patterns, such as social threat, can be discriminated independently of the geniculo-striate pathway.

A novel automated test battery reveals enduring behavioural alterations and cognitive impairments in survivors of murine pneumococcal meningitis

Pneumococcal meningitis, caused by Streptococcus pneumoniae infection, is a major form of lethal bacterial meningitis. Survivors are predisposed to developing lifelong disabling sequelae, including cognitive impairment, psychological problems and motor deficits. In our experimental model, ventricular inoculation of 10(5) colony-forming units of S. pneumoniae type 3 caused 90% of mice to develop life-threatening meningitis within 48 h. Antibiotic treatment with ceftriaxone 20 h post infection reduced the incidence of severe meningitis to <10%. At the time of treatment, upregulation of pro-inflammatory cytokines was detected, including interleukin-1β, interleukin-6 and tumour necrosis factor. We evaluated the long-term behavioural and cognitive sequelae in control mice and those surviving meningitis using an automated system (the IntelliCage) in which mice perform a range of behavioural and spatial tasks to obtain water rewards from conditioning units in their home cage. Surviving mice showed a number of altered behaviours relative to controls, including (i) hypoexploration when first exposed to the IntelliCage, (ii) altered activity patterns (fewer visits to conditioning stations during the light phase and more in the dark phase), (iii) avoidance of light (a constant or flashing LED stimulus), (iv) impaired spatial learning (a complex patrolling task), and (v) impaired discrimination reversal learning. Overall these results suggest photophobia and weakened learning ability in post-meningitic mice, particularly on tasks engaging hippocampal and prefrontal neural substrates. This study also demonstrates a standardised and comprehensive battery of tests that can be readily used to investigate neurological sequelae in undisturbed mice residing in a complex home cage environment.

Lateral entorhinal modulation of piriform cortical activity and fine odor discrimination.

The lateral entorhinal cortex (LEC) receives direct input from olfactory bulb mitral cells and piriform cortical pyramidal cells and is the gateway for olfactory input to the hippocampus. However, the LEC also projects back to the piriform cortex and olfactory bulb. Activity in the LEC is shaped by input from the perirhinal cortices, hippocampus, and amygdala, and thus could provide a rich contextual modulation of cortical odor processing. The present study further explored LEC feedback to anterior piriform cortex by examining how LEC top-down input modulates anterior piriform cortex odor evoked activity in rats. Retrograde viral tracing confirmed rich LEC projections to both the olfactory bulb and piriform cortices. In anesthetized rats, reversible lesions of the ipsilateral LEC increased anterior piriform cortical single-unit spontaneous activity. In awake animals performing an odor discrimination task, unilateral LEC reversible lesions enhanced ipsilateral piriform cortical local field potential oscillations during odor sampling, with minimal impact on contralateral activity. Bilateral LEC reversible lesions impaired discrimination performance on a well learned, difficult odor discrimination task, but had no impact on a well learned simple odor discrimination task. The simple discrimination task was impaired by bilateral reversible lesions of the anterior piriform cortex. Given the known function of LEC in working memory and multisensory integration, these results suggest it may serve as a powerful top-down modulator of olfactory cortical function and odor perception. Furthermore, the results provide potential insight into how neuropathology in the entorhinal cortex could contribute to early olfactory deficits seen in Alzheimer's disease.

The lateralization of gustatory function and the flow of information from tongue to cortex

Controversy surrounds whether crossed and/or uncrossed fibers carry taste information from tongue to cortex and whether there is hemispheric specialization for gustatory processing. The current study examined these issues in 14 patients with unilateral insula lesions, seven with right-sided and seven with left-sided damage, and in 42 healthy controls. Two tasks were carried out, with tastants applied unilaterally to the tongue tip: (1) taste discrimination; and (2) stimulus sampling followed by judgments of quality, intensity, hedonics and name-recognition, for sweet, salty, bitter and sour tastants. Controls were better at discriminating tastants applied to their right tongue tip relative to their left, and better at taste quality judgments when tastants were applied to their left tongue tip relative to their right. Insula lesions to the left or right side resulted in bilateral impairments in discrimination, quality judgments and naming, when compared to controls. However, the Left insula group was poorer on tasks involving salt, and for ipsilateral hedonic judgments, relative to controls and the Right insula group. These findings are consistent with gustatory information ascending from tongue to cortex both ipsilaterally and contralaterally, and provide preliminary support for hemispheric gustatory specialization.

P.2.021 Role of adenosine (A)2A receptor in nicotine addiction – pharmacological and genetic aspects

Therefore, in order to identify the implication of 5-HT7R on the onset of the age-related memory decline, memory performances of 7−8 months-old and 10−12 months-old KO C57BL/6J mice with homozygous disruption of the 5-HT7R gene were compared to paired wild type mice (WT). Recognition memory performances were assessed in a Y-maze with a 1-hour delay between presentation and test [2]. Spatial working memory performances were assessed by recording spontaneous alternation behaviour in a Y-maze during a 5-minutes session. In addition locomotor activity was assessed in an activity cage and anxiety-related behaviour was examined using the elevated plus-maze (EPM). Our data showed that 10−12 months-old WT mice did not discriminate the novel object contrary to 7−8 monthsold WT mice, which spent more time exploring the novel object compared to the chance level (univariate t-test: p< 0.05). In addition, disruption of 5-HT7R led to an impaired object discrimination in 7−8 and 10−12 monthsold mice. By contrast, ANOVA analysis revealed that mutant mice exhibited equivalent levels of spontaneous alternation compared to WT mice (around 75%). In addition, statistical analysis of locomotor activity did not revealed any significant effect of genotype or genotype × age interaction, indicating equivalent basal level of locomotion. Finally, no differences between mice of both genotypes were detected in the global activity or the anxiety-related parameters assessed in the EPM. Our results therefore suggest that in our experimental conditions, the onset of episodic-like memory decline is situated between 7−8 and 10−12 months-old of age in C57BL/6J mice, and that the lack of 5-HT7R could accelerate the onset of this decline, with no relation to any inhibition of locomotor activity or increased anxiety-like behaviour. By contrast, working memory performances seem not to be affected between 7−8 and 10−12 monthsold in KO and WT mice. Further pharmacological (using a selective 5-HT7 antagonist) and molecular (5-HT7R expression) studies in WT mice would confirm this statement.

Diagnostic value of four clinical tests for the evaluation of subscapularis integrity

The lift-off, internal rotation lag sign, belly-press, and bear-hug tests are widely used toevaluate the integrity of the subscapularis. We hypothesized that these tests might reflect different types of subscapularis tears and sought to ascertain whether these tests accurately determine the severity of the internal rotation strength deficit and fatty degeneration. Isokinetic testing and the 4 clinical tests were used preoperatively to evaluate 312 patients who had undergone arthroscopic rotator cuff surgery. Of these, 37 patients had a full-thickness subscapularis tear, 96had a partial-thickness tear, and 179 had no tear. For differentiating any tears from an intact subscapularis, the most sensitive test was the belly-press test (27.8%), and the most specific test was the lift-off test (100%). For differentiating a full-thickness tear from a partial tear, the most sensitive test was the belly-press test (56.8%), and the most specific was the lift-off test (96.9%). A positive lift-off test also most reflected loss of internal rotation strength (mean, 72.2%; 95% confidence interval, 61.9-82.5), followed by the internal rotation lag sign (55.1%; 44.2-66.1) and the belly-press test (45.9%; 36.4-54.4). A positive lift-off test was highly specific for the detection of a full-thickness subscapularis tear and to reflect severe fatty degeneration. The lift-off, internal rotation lag sign, belly-press, and bear-hug tests sequentially predict internal rotation strength deficit and provide discrimination of internal rotation strength impairment.